Had surgery a few years ago and was given 30 tabs of oxycodon. Like your friend I only a few of them and held on to the rest for almost three years because I wasn’t sure what to do with it....
Had surgery a few years ago and was given 30 tabs of oxycodon. Like your friend I only a few of them and held on to the rest for almost three years because I wasn’t sure what to do with it. Finally found out that the local PD was taking them and brought them in.
Maybe things have changed, but I think controlled substances should come with instructions for proper disposal, whether it’s a way to destroy them at home or something as simple as directing a person to return them or bring them to a police station. Heck, give people a nominal amount of money or coupons for returning unused pain meds if that encourages people to bring them in.
Without a doubt, the exponential rise in opioid ODs is mainly from heroin, fentanyl, and carfentanyl and there are many diversion tactics being played by the FDA, but to say that prescription...
Without a doubt, the exponential rise in opioid ODs is mainly from heroin, fentanyl, and carfentanyl and there are many diversion tactics being played by the FDA, but to say that prescription opioid pain killers haven't played their part in fueling the epidemic (which I'm not sure if that's what you're trying to do or not) is misleading.
From the article you posted directly:
74.9% of nonmedical opioid use happens as a result of people taking medication they were not prescribed, such as those obtained or stolen from a friend or drug dealer.
And also:
Prescriptions, given to patients adequately screened by and in possession of a good relationship with the physician, and used by the patient for which they were prescribed, simply are not the cause of the majority of opioid use disorders — diverted prescriptions and irresponsible mass scripts from so‐called “pill mills” are. You may have heard the small West Virginian town of Kermit mentioned in the news recently due to one of their drugstores: “In just two years, drug wholesalers shipped 9 million opioid pills to a pharmacy in Kermit, WV, a town of just 400 people.”
What these two things are saying are that prescription opioids did, in fact, cause many to become addicted to opioids, however, many of them weren't opioids that were prescribed to those individuals directly but came from indirect means. I study public health and have been off-and-on involved in Philadelphia's overdose prevention efforts, volunteer at needle exchanges, carry narcan, support SICs, and have worked directly with addicted populations in clinical and non-clinical settings. The amount of times you'll hear the story "my friend gave me vicodin for some back pain I was having and it all started there" is demoralizing. BUT, what ends up happening is, as you pointed out, Heroin (especially in Philadelphia) is much cheaper than RX opioids on the street, and it's also much more pure so you'll get a stronger high. So, the majority of users move on from prescription opioids onto heroin (even when they say they never will) because of economic necessity. The overdoses are coming now because of the trace amounts of synthetic opioids cut into products often aren't detectable to most users and because very very very few people actually have the means to test the drugs they're using.
It IS unfortunate that individuals suffering from chronic pain who take prescription opioids to manage are being vilified and are finding less and less ways to get the help they need, I don't disagree. But it's also unfortunate that people are prescribed 30 day supplies of vicodin for wisdom teeth removals, when most people only use one or two doses, or that drug disposal programs aren't as widespread or were too slow to help people when they needed it most. It's upsetting that medical licenses of providers who've either started or continue to perpetuate pill mills are still going on today in many cases. And all this shit hasn't even begun to talk about the racial stigma of prescription practices or of how the US has "treated" drug users. Or about how pharmaceutical companies were less than honest about the addictive-ness of opioids when pitching them to physicians.
I feel like I got a bit carried away, but my main point in all this is that prescription opioids aren't the direct cause of the current opioid epidemic, but they absolutely did (and in some cases, still do) play a role. But there are many other causes (socially, economically, and politically) that are also important to look at too.
I haven't read Chopincake's comment so I apologize if I'm just repeating information. While prescription opioids aren't the sole cause of the opioid epidemic, it's a bit short-sighted to say that...
I haven't read Chopincake's comment so I apologize if I'm just repeating information. While prescription opioids aren't the sole cause of the opioid epidemic, it's a bit short-sighted to say that they had no role. Pill mills and nefarious marketing campaigns by pharmaceutical companies (In particular Purdue) are largely responsible for the influx of often-times unnecesary pharmaceutical opioids to the American public. OxyContin was marketed as a non-addictive alternative to conventional opioids, despite Purdue having known that this was not the case. If you're interested in the subject, you should read Dreamland: The True Tale of America's Opiate Epidemic by Sam Quinones. If you want to delve deeper, however, the ultimate cause of America's heroin/opioid crisis is a cultural illness of hyper-consumerism and social disconnect. Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari is another good read on this last point specifically.
Edit: I read your article and now see that you made many of the same points that I did. I understand your central point, but it is important to note that pill mills and the over-perscription of opioids by doctors are often legal practices.
The letter that started it all: https://www.bbc.co.uk/news/world-us-canada-40136881 That letter was used extensively to increase treatment of pain with opioid medication. The veteran's association...
The original letter, titled "Addiction Rare in Patients Treated with Narcotics", was just a paragraph long. The lone evidence cited was an anecdote that out of 11,882 hospitalised patients were treated with narcotics, only four patients with no history of addiction became addicted.
That letter was used extensively to increase treatment of pain with opioid medication.
The veteran's association then had a campaign to recognise and treat pain. They called pain the 5th vital sign.
This meant that all health care practitioners were asking patients about pain. Once you've found someone has pain you'll want to treat it, and physiotherapy is hard to access; people reject (especially in 2000) psychological treatment for pain; and people thought that opioids were not addictive if used to treat pain.
The other things that contributed were medication companies designing meds to have different withdrawal profiles, which probably contributed to addictiveness. These were aggressibely marketed as less addictive. And some companies turned a blind eye to obviously flagrantly abusive prescribing - so called pill mills could have been easily stopped if pharma companies had not ignored their data.
Turns out that pain is complex, and that opioids are a poor choice for many (not all) people with long term pain. They develop a tolerance, and need higher doses, but you can't increase the dose too much because it's toxic. So you have people taking dangerously large doses, addicted to opioids, and still in pain.
One last point: The hidden victims in the death toll are the grandchildren who visit their grandparents, and who accidentally take the pills. Some old people don't think to keep pills safe because they don't have children in the house everyday. So when the family visits these pills are sometimes easy to get hold of. Please keep meds in a safe place.
Your link is so wrong it's impossible to list all the ways it is wrong. It's an incoherent mess and it flies in the face of all the medical evidence we have about opioid prescribing. I mean, that...
Your link is so wrong it's impossible to list all the ways it is wrong. It's an incoherent mess and it flies in the face of all the medical evidence we have about opioid prescribing.
Yet the threat of addiction largely comes from diverted prescription opioids, not from long-term use with a skilled prescriber in a longitudinal clinical relationship.
I mean, that sentence includes the myth that most prescribed opioids are used with a skilled prescriber in a long term clinical relationship (that's not always true in the US), that the massive over-supply of prescribed opioids doesn't somehow contribute to the problem of diversion (of course it does), and that prescription opioids are an effective treatment for long term pain (for most patients they aren't effective or safe).
74.9% of nonmedical opioid use happens as a result of people taking medication they were not prescribed, such as those obtained or stolen from a friend or drug dealer. A further 3.1% fraudulently obtained prescriptions from multiple doctors, a practice called “doctor‐hopping”. That’s a total of 78% of sources other than a relationship with a single doctor. That leaves 22% of those who were addicted who do receive their pills from a doctor, but that number must be put into perspective.
The author ignores in this 78% figure the number of people who started their addiction with legally prescribed opioids. In the US that's a considerable number of people, because ...
A Cochrane review of opioid use in chronic non‐cancer pain found that fewer than one percent of people who were responsibly prescribed opioids developed an addiction.
...because the vast majority of opioid prescring in the US is not responsible. It's irresponsible.
That medium post also selctively, misleadingly, quotes the research it sites. Here's the preamble to that Cochrane review:
The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment.
Note this is very different from what the medium post is saying. It includes phrases such as "proper management" (tends not to happen in the US), "well-selected" (again, not the US). It also tells us that this evidence is weak. Just this bit of misrepresentation means I'm going to ignore the rest of that medium blog.
Really, if you read anything in my previous post read the RCoA links about opioid aware.
Other countries are not having an opioid crisis anywhere near the US levels, and that's because they don't prescribe anywhere near the US levels.
EDIT: A further example of misrepresenting the data:
We need to break some statistics down. According to the 2014 National Survey on Drug Use and Health, 74.9% of nonmedical opioid use happens as a result of people taking medication they were not prescribed, such as those obtained or stolen from a friend or drug dealer. A further 3.1% fraudulently obtained prescriptions from multiple doctors, a practice called “doctor‐hopping”. That’s a total of 78% of sources other than a relationship with a single doctor. That leaves 22% of those who were addicted who do receive their pills from a doctor, but that number must be put into perspective.
The chart they're talking about is this one: "Source for Most Recent Nonmedical Use
among Past Year Pain Reliever Users".
That chart includes this line:
From Friend or Relative for Free 54.0a 50.5 46.1 43.1 52.3 50.0 56.2a 51.8
That's the percentages of people who got their non-medically used opioids for free from their friends. They can only do this because opioids are massively over-prescribed in the US. It's is clearly dishonest to exclude this line from the medium post. Those authors are dishonest.
I'm saying that we don't need to. The over-prescibing of opioids in the US is so drastic that they could reduce it by something like 80% and still keep everyone in chronic pain on opioids. I'm...
I’m arguing that we cannot sacrifice chronic pain patients in the pursuit of no greater metric than “fewer opioid prescriptions”.
I'm saying that we don't need to. The over-prescibing of opioids in the US is so drastic that they could reduce it by something like 80% and still keep everyone in chronic pain on opioids.
I'm also saying that this kind of long term use of opioids is, for most but not all patients, unlikely to provide adequate pain relief.
The US uses 99% of the world supply of hydrodone. It's hard to believe all of that is "well managed" to "carefully selected" patients who get any benefit from it. It's very easy to believe that it's causing massive amounts of addiction and death, because we can count all the dead people and all the opioid addicts. WHO data show that use of street opioids like heroin roughly matches that seen in Europe, but non-medical use of medical opioids is significantly higher than Europe.
Had surgery a few years ago and was given 30 tabs of oxycodon. Like your friend I only a few of them and held on to the rest for almost three years because I wasn’t sure what to do with it. Finally found out that the local PD was taking them and brought them in.
Maybe things have changed, but I think controlled substances should come with instructions for proper disposal, whether it’s a way to destroy them at home or something as simple as directing a person to return them or bring them to a police station. Heck, give people a nominal amount of money or coupons for returning unused pain meds if that encourages people to bring them in.
Without a doubt, the exponential rise in opioid ODs is mainly from heroin, fentanyl, and carfentanyl and there are many diversion tactics being played by the FDA, but to say that prescription opioid pain killers haven't played their part in fueling the epidemic (which I'm not sure if that's what you're trying to do or not) is misleading.
From the article you posted directly:
And also:
What these two things are saying are that prescription opioids did, in fact, cause many to become addicted to opioids, however, many of them weren't opioids that were prescribed to those individuals directly but came from indirect means. I study public health and have been off-and-on involved in Philadelphia's overdose prevention efforts, volunteer at needle exchanges, carry narcan, support SICs, and have worked directly with addicted populations in clinical and non-clinical settings. The amount of times you'll hear the story "my friend gave me vicodin for some back pain I was having and it all started there" is demoralizing. BUT, what ends up happening is, as you pointed out, Heroin (especially in Philadelphia) is much cheaper than RX opioids on the street, and it's also much more pure so you'll get a stronger high. So, the majority of users move on from prescription opioids onto heroin (even when they say they never will) because of economic necessity. The overdoses are coming now because of the trace amounts of synthetic opioids cut into products often aren't detectable to most users and because very very very few people actually have the means to test the drugs they're using.
It IS unfortunate that individuals suffering from chronic pain who take prescription opioids to manage are being vilified and are finding less and less ways to get the help they need, I don't disagree. But it's also unfortunate that people are prescribed 30 day supplies of vicodin for wisdom teeth removals, when most people only use one or two doses, or that drug disposal programs aren't as widespread or were too slow to help people when they needed it most. It's upsetting that medical licenses of providers who've either started or continue to perpetuate pill mills are still going on today in many cases. And all this shit hasn't even begun to talk about the racial stigma of prescription practices or of how the US has "treated" drug users. Or about how pharmaceutical companies were less than honest about the addictive-ness of opioids when pitching them to physicians.
I feel like I got a bit carried away, but my main point in all this is that prescription opioids aren't the direct cause of the current opioid epidemic, but they absolutely did (and in some cases, still do) play a role. But there are many other causes (socially, economically, and politically) that are also important to look at too.
I haven't read Chopincake's comment so I apologize if I'm just repeating information. While prescription opioids aren't the sole cause of the opioid epidemic, it's a bit short-sighted to say that they had no role. Pill mills and nefarious marketing campaigns by pharmaceutical companies (In particular Purdue) are largely responsible for the influx of often-times unnecesary pharmaceutical opioids to the American public. OxyContin was marketed as a non-addictive alternative to conventional opioids, despite Purdue having known that this was not the case. If you're interested in the subject, you should read Dreamland: The True Tale of America's Opiate Epidemic by Sam Quinones. If you want to delve deeper, however, the ultimate cause of America's heroin/opioid crisis is a cultural illness of hyper-consumerism and social disconnect. Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari is another good read on this last point specifically.
Edit: I read your article and now see that you made many of the same points that I did. I understand your central point, but it is important to note that pill mills and the over-perscription of opioids by doctors are often legal practices.
The letter that started it all: https://www.bbc.co.uk/news/world-us-canada-40136881
That letter was used extensively to increase treatment of pain with opioid medication.
The veteran's association then had a campaign to recognise and treat pain. They called pain the 5th vital sign.
https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf
This meant that all health care practitioners were asking patients about pain. Once you've found someone has pain you'll want to treat it, and physiotherapy is hard to access; people reject (especially in 2000) psychological treatment for pain; and people thought that opioids were not addictive if used to treat pain.
Americans use vast quantities of opioids. Many of these are legally prescribed. You can see here: http://www.painpolicy.wisc.edu/who-regional-office-americas-amro
For example, the US was consuming 99% of the world supply of hydrocodone. https://www.washingtonpost.com/news/wonk/wp/2017/03/15/americans-use-far-more-opioids-than-anyone-else-in-the-world/?utm_term=.b5705cca9112
The other things that contributed were medication companies designing meds to have different withdrawal profiles, which probably contributed to addictiveness. These were aggressibely marketed as less addictive. And some companies turned a blind eye to obviously flagrantly abusive prescribing - so called pill mills could have been easily stopped if pharma companies had not ignored their data.
Turns out that pain is complex, and that opioids are a poor choice for many (not all) people with long term pain. They develop a tolerance, and need higher doses, but you can't increase the dose too much because it's toxic. So you have people taking dangerously large doses, addicted to opioids, and still in pain.
The Royal College of Anaesthetists has more information about safer prescribing of opioids. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware
One last point: The hidden victims in the death toll are the grandchildren who visit their grandparents, and who accidentally take the pills. Some old people don't think to keep pills safe because they don't have children in the house everyday. So when the family visits these pills are sometimes easy to get hold of. Please keep meds in a safe place.
Your link is so wrong it's impossible to list all the ways it is wrong. It's an incoherent mess and it flies in the face of all the medical evidence we have about opioid prescribing.
I mean, that sentence includes the myth that most prescribed opioids are used with a skilled prescriber in a long term clinical relationship (that's not always true in the US), that the massive over-supply of prescribed opioids doesn't somehow contribute to the problem of diversion (of course it does), and that prescription opioids are an effective treatment for long term pain (for most patients they aren't effective or safe).
The author ignores in this 78% figure the number of people who started their addiction with legally prescribed opioids. In the US that's a considerable number of people, because ...
...because the vast majority of opioid prescring in the US is not responsible. It's irresponsible.
That medium post also selctively, misleadingly, quotes the research it sites. Here's the preamble to that Cochrane review:
Note this is very different from what the medium post is saying. It includes phrases such as "proper management" (tends not to happen in the US), "well-selected" (again, not the US). It also tells us that this evidence is weak. Just this bit of misrepresentation means I'm going to ignore the rest of that medium blog.
Really, if you read anything in my previous post read the RCoA links about opioid aware.
Other countries are not having an opioid crisis anywhere near the US levels, and that's because they don't prescribe anywhere near the US levels.
EDIT: A further example of misrepresenting the data:
They then link to this: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-47b
The chart they're talking about is this one: "Source for Most Recent Nonmedical Use
among Past Year Pain Reliever Users".
That chart includes this line:
That's the percentages of people who got their non-medically used opioids for free from their friends. They can only do this because opioids are massively over-prescribed in the US. It's is clearly dishonest to exclude this line from the medium post. Those authors are dishonest.
I'm saying that we don't need to. The over-prescibing of opioids in the US is so drastic that they could reduce it by something like 80% and still keep everyone in chronic pain on opioids.
I'm also saying that this kind of long term use of opioids is, for most but not all patients, unlikely to provide adequate pain relief.
The US uses 99% of the world supply of hydrodone. It's hard to believe all of that is "well managed" to "carefully selected" patients who get any benefit from it. It's very easy to believe that it's causing massive amounts of addiction and death, because we can count all the dead people and all the opioid addicts. WHO data show that use of street opioids like heroin roughly matches that seen in Europe, but non-medical use of medical opioids is significantly higher than Europe.